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Biomedical subjects

C B Wilmot

Publications and source records attributed to C B Wilmot.

12 recordsLinked to original sources
PubMed1990

Benefits of early admission to a comprehensive trauma center for patients with spinal cord injury.

Patients with spinal cord injury may be admitted directly to a trauma center with a dedicated rehabilitation unit or transferred there days or weeks later. This study analyzed the relationship between time of transfer to a Level I Trauma Center with a spinal cord injury service and efficacy of subsequent rehabilitation. We examined the records of all patients admitted to the service between September 1981 and August 1983 and followed at least one year. There were 197 patients, 102 quadriplegics and 95 paraplegics, aged 15 to 77 years (average = 29.4 years). Median time from injury to admission was 11 days for quadriplegics and 21 days for paraplegics; this was used to define early and late groups. The early quadriplegic group began rehabilitation 2.94 days postinjury; the late quadriplegic group, 74.87 days (p less than .01). Time in rehabilitation did not differ (128.22 days, early; 122.61, late), but total hospitalization--from injury to discharge--was 131.16 days for the early quadriplegic group and 197.27 for the late quadriplegic group (p less than .01). Average duration of prerehabilitation care for the paraplegic groups was 6.19 days (early) and 58.58 days (late) (p less than .01). Time in rehabilitation was the same for both paraplegic groups, but total hospitalization was shorter for early admissions (82.91 days vs 125.90 days, p less than .01).(ABSTRACT TRUNCATED AT 250 WORDS)

Cost-Benefit Analysis↗
PubMed1988

Pneumobelt use among high quadriplegic population.

This study reviews pneumobelt use in an acute rehabilitation facility. All pneumobelt users between 1976 and 1986 were identified. Their age, sex, diagnosis, and time required to adjust to the pneumobelt were studied, as were patterns of use at discharge. Information was collected about use after discharge and about reported advantages and disadvantages. Twenty-three subjects were identified: 21 had spinal cord injuries (SCI), two had had poliomyelitis. The average pneumobelt fitting was three to six months after injury. Twelve SCI patients attained four or more hours of continuous, generally all-day use; another patient achieved this after discharge. Of the remaining eight SCI subjects, all achieved a minimum of two hours of continuous use. The two poliomyelitis patients also achieved all-day use. The survey revealed a high level of satisfaction and continued pneumobelt use after discharge. Major reported advantages were cosmesis, improved speech, independence and mobility, comfort, safety, and health. The pneumobelt is recommended as a leading choice for interim or permanent ventilation of the high quadriplegic population without severe brainstem involvement.

Activities of Daily Living↗
PubMed1986

Evaluation of acute surgical intervention in traumatic paraplegia.

A retrospective study was conducted over a two-year period of 95 consecutive admissions for traumatic paraplegia. The average age was 32 years. Seventy-two (76%) of these patients had acute surgical intervention. Fifty had Harrington rod placement with posterior fusion, 10 had additional laminectomy and one had rodding and anterior fusion. Seven laminectomies (alone) were performed at other hospitals. For those with rodding and/or fusion, rehabilitation stay was 70 days; for those with no surgery, 81 days. This difference was not statistically significant. However, when days of acute medical/surgical and rehabilitation hospitalization were combined, those having spinal surgery of any kind had a significantly shorter stay than those not having surgery (95 vs. 136 days). Complications were significantly greater in the patients who underwent internal fixation surgery. The neurological condition did not appear to be jeopardized by rodding and fusion.

Adult↗
PubMed1986

Evaluation of the acute management of tetraplegia: conservative versus surgical treatment.

A retrospective study of 106 tetraplegic patients admitted consecutively to the Santa Clara Valley Medical Center (SCVMC) between August, 1981 and September, 1983 was conducted. The average age was 28; and 20 (19%) were female. The majority sustained their spinal cord injury in a motor vehicle accident (65%) or in a diving accident (19%). Forty-nine percent (52/106) of these patients had acute surgical intervention, and 63% (33/52) of these patients had this prior to admission to SCVMC. The majority (35/52) had posterior fusion alone. Twelve patients had an anterior fusion (11 at other hospitals) and four a laminectomy alone (three carried out at other hospitals). The length of rehabilitation stay was 133 days for those having surgery, and 119 days for non-surgical cases; statistically a non-significant difference. When acute medical/surgical hospitalisation and rehabilitation days were combined, those having surgery had a significantly longer stay (197 versus 153 days), but only when surgery was done other than at SCVMC. Complications occurred in 50/106 (47%) of the patients: 50% who had surgery and 44% who were treated conservatively. The most commonest complication was respiratory (43%), including 20% who had pneumonia. Complications were no greater in those patients who underwent posterior fusion than in those who had no spinal surgery. However, other types of surgery carried a higher risk of complications by approximately 20%. Anterior fusions and laminectomies, performed almost totally at other institutions (15/17), had a higher rate of complications.

Adult↗
PubMed1985

Occult head injury: its incidence in spinal cord injury.

This study investigated the suspicion that a significant proportion of individuals having spinal cord injury (SCI) also sustain a concomitant undiagnosed occult head injury during the trauma accident. The criteria for high risk of head injury included the following: (1) quadriplegia with high energy deceleration accident, (2) loss of consciousness at time of injury, (3) brainstem or cortical neurologic indicators, or (4) respiratory support required at time of injury. In this study, 67 patients admitted to the rehabilitation unit were given a neuropsychologic evaluation a median of 48 days after injury. Motor free scales used were the Galveston Orientation and Amnesia Test (GOAT), Quick Test, Raven Progressive matrices, serial 7s, Shipley Hartford, Stroop Color/Word Interference, and the Wechsler Memory Scale Associate Learning Tests. Forty-three of the 67 patients (64%) scored mildly to profoundly impaired on the test battery. Evidence of poor premorbid academic history was present in 19 (44%) of those with impaired performance on the neurologic evaluation and in only three (13%) of those scoring unimpaired. Consequently, 56% (24/43) of the impaired had no previous record of scholastic difficulties, presumably acquiring cognitive impairment at the time of injury. The implications of this high incidence of impaired cognitive functioning for treatment of individuals with SCI are significant.

Adolescent↗
PubMed1984

Acute abdominal emergencies during the first four weeks after spinal cord injury.

Diagnosing acute abdominal emergencies during spinal shock can be extremely difficult. Generally, the abdominal examination of an acutely cord-injured patient will not change with abdominal pathology. Loss of sensory, motor, and reflex functions mask typical signs. Nine hundred and forty-five medical charts were retrospectively examined to determine the incidence, causes, and risk factors for acute abdominal pathology during the first four weeks after spinal cord injury. Time of greatest risk was also investigated. Intraabdominal pathology was seen in 4.7% of the cases. Patients with complete cord lesions above the T5 level were most at risk. Respiratory distress was an additional risk factor for peptic ulcer disease. Decadron was found to be associated with pancreatitis but not with ulcers. Both pancreatitis and upper gastrointestinal hemorrhage appeared as early as three days postinjury. Findings of this study, as well as an understanding of the pathophysiology, symptomatology, and proper diagnostic workup assist in making the critical diagnosis.

Abdomen, Acute↗
PubMed1980

Neurogenic respiratory failure: a 5-year experience using implantable phrenic nerve stimulators.

During the past 5 years, 20 phrenic nerve stimulators have been implanted in 11 patients who were ventilator dependent because of neurogenic respiratory failure. Ten patients had traumatic spinal cord lesions; the remaining patient suffered from a progressive demyelinating disease. There was no operative mortality. Complications included 1 stimulator malfunction and 1 pneumothorax. In spite of adjacent tracheostomies, there were no infections or wound complications. Of the 20 stimulators implanted, 13 initially produced good diaphragmatic function, 2 had fair function, and 5 had little or not function. Three patients became completely independent of their ventilators; 6 became partially independent, thus simplifying nursing care. There were no late complications. As of December, 1979, 7 patients had benefited or were continuing to benefit from phrenic nerve stimulation.

Adolescent↗
PubMed1979

Post-void residual alerting device.

A simple, inexpensive device is described which alerts nursing staff upon spontaneous voiding by a patient with spinal cord injury. This facilitates measurement of the post-void residual urine volume which is useful in the management of neurogenic bladder.

Humans↗
PubMedDate not supplied

Nutritional and metabolic response to acute spinal-cord injury.

The metabolic response to complete spinal cord injury was prospectively studied in 10 patients with Frankel class A spinal cord injury. Weekly excretory and balance studies profile the changes in nitrogen, calcium, and 3-methylhistidine excretion in relation to body weight and metabolic rate. The initial resting energy expenditures were 10% below what was predicted, and body weight decreased by 10%. Nitrogen excretion paralleled the changes in body weight. Calcium excretion increased for 3 weeks and reached a plateau 150% above baseline. Our results chronicle the magnitude of metabolic response to spinal shock. Comparison with reported values shows this response exceeds that seen in immobilized patients. Nitrogen excretion rose to levels seen in highly stressed patients and must be considered in the management of patients with acute spinal-cord injury.

Acute Disease↗